University of Pennsylvania, Perelman School of Medicine, Philadelphia.
Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha.
Arthritis Care Res (Hoboken). 2020 Mar;72(3):326-333. doi: 10.1002/acr.23873.
In rheumatoid arthritis, whether women are less likely to achieve low disease activity is unclear. We evaluated sex differences in remission and low disease activity, comparing different clinical and imaging measures.
We used data from the Veterans Affairs Rheumatoid Arthritis (VARA) registry and from 2 clinical trials. Remission and low disease activity were defined using composite scores, individual items (tender joints, swollen joints, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP] level, and evaluator/patient global assessment), and magnetic resonance imaging (MRI). In the VARA registry, we assessed the likelihood of point remission at any time during follow-up using logistic regression, and time to sustained remission (2 consecutive visits) using Cox proportional hazards models. In the clinical trials, logistic regression models evaluated the likelihood of low clinical and MRI activity at 52 weeks.
Among 2,463 patients in VARA, women (10.2%) were less likely to be in Disease Activity Score in 28 joints (DAS28)-ESR remission in follow-up (odds ratio [OR] 0.71 [95% confidence interval (95% CI) 0.55-0.91]; P < 0.01) and had a longer time to sustained DAS28-ESR remission. This difference was not observed for DAS28-CRP, Clinical Disease Activity Index, or Routine Assessment of Patient Index Data 3. Women were more likely to achieve favorable individual components except for an ESR <30 mm/hour (OR 0.72 [95% CI 0.57-0.90]; P < 0.01). Among 353 trial participants (83.7% women), women had reduced rates of DAS28-ESR remission (OR 0.39 [95% CI 0.21-0.72]; P = 0.003) but similar rates of low MRI synovitis and osteitis.
The comparison of remission rates between men and women varies based on the disease activity measure, with sex-specific differences in ESR resulting in reliably lower rates of remission among women. There were no differences in MRI measures.
在类风湿关节炎中，女性不太可能达到低疾病活动状态的原因尚不清楚。我们评估了缓解和低疾病活动状态方面的性别差异，比较了不同的临床和影像学指标。
我们使用了退伍军人事务部类风湿关节炎（VARA）登记处和 2 项临床试验的数据。缓解和低疾病活动状态使用综合评分、个别项目（压痛关节、肿胀关节、红细胞沉降率[ESR]、C 反应蛋白[CRP]水平和评估者/患者总体评估）和磁共振成像（MRI）来定义。在 VARA 登记处，我们使用逻辑回归评估了在随访期间任何时间点达到点缓解的可能性，并使用 Cox 比例风险模型评估了持续缓解（连续 2 次就诊）的时间。在临床试验中，逻辑回归模型评估了在 52 周时达到低临床和 MRI 活动的可能性。
在 2463 名 VARA 患者中，女性（10.2%）在随访中达到 28 关节疾病活动评分（DAS28）-ESR 缓解的可能性较低（比值比[OR]0.71[95%置信区间（95%CI）0.55-0.91]；P<0.01），且达到持续 DAS28-ESR 缓解的时间更长。这一差异在 DAS28-CRP、临床疾病活动指数或常规评估患者指数数据 3 中并未观察到。女性更有可能达到有利的个别组成部分，除了 ESR<30mm/hour 外（OR0.72[95%CI0.57-0.90]；P<0.01）。在 353 名试验参与者（83.7%为女性）中，女性达到 DAS28-ESR 缓解的比率较低（OR0.39[95%CI0.21-0.72]；P=0.003），但低 MRI 滑膜炎和骨炎的比率相似。
根据疾病活动测量，男性和女性之间缓解率的比较存在差异，ESR 的性别特异性差异导致女性缓解率确实较低。MRI 测量无差异。
